Abstract：
OBJECTIVE: Heparin-induced thrombocytopenia is a known complication of heparin exposure with potentially life-threatening sequelae. Direct thrombin inhibitors can be substituted for heparin in patients with heparin-induced thrombocytopenia that require anticoagulation. However, the use of direct thrombin inhibitors as a substitute for heparin has not been widely reported in the neuroendovascular literature.
METHODS: Here we report the first use of the direct thrombin inhibitor bivalirudin in a neuroendovascular procedure as a substitute for heparin in a patient with a ruptured pseudoaneurysm and heparin-induced thrombocytopenia, and review the literature on the use of bivalirudin and argatroban for such patients.
RESULTS: Bivalirudin was safely and effectively used in the case reported, with no thrombotic or hemorrhagic complications. Our literature review revealed a paucity of studies on the use of heparin alternatives, including bivalirudin, in neuroendovascular procedures in patients with heparin-induced thrombocytopenia.
CONCLUSIONS: Heparin-induced thrombocytopenia is an important iatrogenic disease process in patients undergoing neuroendovascular procedures, and developing protocols to diagnose and manage heparin-induced thrombocytopenia is important for healthcare systems. While further research needs to be done to establish the full range of anticoagulation options to substitute for heparin, our case indicates bivalirudin as a potential candidate.
METHODS: Here we report the first use of the direct thrombin inhibitor bivalirudin in a neuroendovascular procedure as a substitute for heparin in a patient with a ruptured pseudoaneurysm and heparin-induced thrombocytopenia, and review the literature on the use of bivalirudin and argatroban for such patients.
RESULTS: Bivalirudin was safely and effectively used in the case reported, with no thrombotic or hemorrhagic complications. Our literature review revealed a paucity of studies on the use of heparin alternatives, including bivalirudin, in neuroendovascular procedures in patients with heparin-induced thrombocytopenia.
CONCLUSIONS: Heparin-induced thrombocytopenia is an important iatrogenic disease process in patients undergoing neuroendovascular procedures, and developing protocols to diagnose and manage heparin-induced thrombocytopenia is important for healthcare systems. While further research needs to be done to establish the full range of anticoagulation options to substitute for heparin, our case indicates bivalirudin as a potential candidate.
摘要：
目的：肝素诱导的血小板减少症是肝素暴露的一种已知并发症，有可能危及生命的后遗症。在需要抗凝的肝素诱导的血小板减少症患者中，直接凝血酶抑制剂可以代替肝素。然而,在神经血管内文献中尚未广泛报道使用直接凝血酶抑制剂替代肝素.
方法：在这里，我们报告了直接凝血酶抑制剂比伐卢定在神经血管内手术中作为肝素的替代品首次用于假性动脉瘤破裂和肝素诱导的血小板减少症患者，并回顾了有关此类患者使用比伐卢定和阿加曲班的文献。
结果：Bivalirudin在报告的病例中安全有效地使用，无血栓性或出血性并发症.我们的文献综述显示，关于使用肝素替代品的研究很少，包括比瓦卢定,在肝素诱导的血小板减少症患者的神经血管内手术中。
结论：肝素诱导的血小板减少症是接受神经血管内手术的患者的一个重要的医源性疾病过程，制定诊断和管理肝素诱导的血小板减少症的方案对医疗保健系统很重要。虽然需要进一步的研究来确定替代肝素的各种抗凝方案，我们的案例表明比瓦卢定是一个潜在的候选药物.
方法：在这里，我们报告了直接凝血酶抑制剂比伐卢定在神经血管内手术中作为肝素的替代品首次用于假性动脉瘤破裂和肝素诱导的血小板减少症患者，并回顾了有关此类患者使用比伐卢定和阿加曲班的文献。
结果：Bivalirudin在报告的病例中安全有效地使用，无血栓性或出血性并发症.我们的文献综述显示，关于使用肝素替代品的研究很少，包括比瓦卢定,在肝素诱导的血小板减少症患者的神经血管内手术中。
结论：肝素诱导的血小板减少症是接受神经血管内手术的患者的一个重要的医源性疾病过程，制定诊断和管理肝素诱导的血小板减少症的方案对医疗保健系统很重要。虽然需要进一步的研究来确定替代肝素的各种抗凝方案，我们的案例表明比瓦卢定是一个潜在的候选药物.
